BCBS of MI (Waive6Months)

Hey Everyone, Sorry newbie to the MI Thread. I am from the West Side but my insurance is BCBS of MI. There is a little bullet point on my criteria sheet saying that patients with a BMI over 50 can have the 6 month supervised diet waived? Anyone successful with that?

Wow!  That's great. Well not that a BMI over 50 is a good thing, but I'm glad to see your insurance company recognizes that.  I do not have this type of insurance, but my BMI was 51 and my insurance did require a supervised diet, which I had prior to even looking into the surgery.  I would think that if that comes from you insurance criteria sheet, and your BMI is over 50, then you shouldn't have any problems with it.  Good luck!  And WELCOME!  Tina

I had my procedure done in Sep 07, so the insurance may have changed, but I have BCBS of MI and I did not have to do a 6 month supervised diet.  I looked first contact at all with any doctor was Aug 07 and I had it done is Sep 07.

Good luck to you!!

I have BCBS of MI and the insurance said 6mo diet history and the union said I needed a 12mo diet history.

My BMI was 52 and it seems everything was wavied since I was approved in a month's time from starting the process. First appointment was Feb 5th March5th I was approved. My VSG surgery is set for April 24th.

It sucks I had a BMI of 52 but grateful at the same time because if I wasn't that heavy I wouldn't be approved and I wouldn't have had a surgery date by now.

Mine's right around 50, and I have BCBS MI PPO and it's waived for me (because of the BMI). On the one hand, it sucks that my BMI is so high. On the other, it makes it a bit easier for me for the ins. co. to pay for it.

They aren't even asking me anything about it because of my BMI.

I'm slightly confused though because BCBS PPO told me they don't do approvals or pre-authorizations. You get the surgery and then they make the payment for it. If you meet all the criteria, they pay for it.

How are you guys getting pre-approvals/authorizations?

Before surgery, your surgeons office gets it approved.  I wouldnt have the surgery until it was approved!!! Or you will end up with one heck of a bill $$$$$$$$$

Shannon

bcbs does not pre auth- need to meet the requirements of your prorgram, then your program gets it approved before the surgery.

Mine was waived last January when the criteria changed. 

The approved me at the end of January, started my pre-op diet 2nd week of Feb and surgery was March 4th....

If your BMI is over 50, and you meet the other criteria, you should be fine!!!!

GOOD LUCK... let us know how it goes!

Yes- that is true!  WHen I worked for a bariatric program that rule just went into effect!!!  Best of luck!!

I have BCBS of MI (PPO) and yes, that bullet point is correct.  They changed the criteria about a year ago (January 08, I think).  BMI over 50 doesn't need the 6-month diet (it used to be 12 months). 

And BCBS/MI does NOT do pre-approval or pre-authorization of the surgery.  (You don't have to gather all your paperwork and mail it to insurance for review before surgery like most folks do.)  Basically you need to know what the criteria is and make sure you fulfill all those criteria before surgery ... then the surgeon submits the bill after surgery for payment.  The surgeon's office knows this about BCBS, so they certainly are not going to do the surgery unless they are sure they'll get paid.  This is how it's been for at least the past 2 years because I didn't have a pre-approval process.

When I was "approved" my approval came from Hurley, not BCBS.  Once the last of my paperwork was submitted (in my case it was my PCP letter), I got the call within 24 hours of them having everything in my file and I was scheduled within 3.5 weeks of that call.

So make sure that you have called your insurance company on  your own (the number on the back of your card) and gotten a copy of the exact criteria sent to you in writing.  Then use that as your checklist for making sure you have everything done.  Don't rely on your surgeon's office to do this part for you -- yes, they'll do it, but you need to make sure you're checking up on them as the process goes along.  Nobody cares more about your health than YOU do, so be your own best advocate.

Good luck with the process!  You'll be on the losers bench before you know it!  :-)

Pam